Genetic Testing for Smoking Cessation

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Smokers' ability to
quit smoking may be influenced by genetic variation. The use of genetic testing
may hence increase cessation rates.

Genetic Testing for Smoking Cessation

More than 1.2 billion
smokers exist worldwide, and tobacco smoking continues to be the largest
preventable cause of disease and premature death.
With smoking it is true that cessation reverses most of its adverse effects.
Although many pharmacological therapies are available, even then the cessation
rate remains low as 15% to 30% which gives way to genetically tailored therapies
like nicotine dependence tests. Inherited or genetic differences in nicotine
clearance rates are associated with smoking behavior and cessation rates, with
a genetically-informed biomarker, the nicotine metabolite ratio, NMR.

In
a cross sectional survey conducted in Netherlands, the knowledge of smokers,
their attitudes, preferences and intention to undergo genetic testing were
assessed using an online cross-sectional survey. Total of 587 participants were
selected from the database of an internet research company.

They were queried with
their smoking characteristics like type of tobacco product, number of
cigarettes and/or shags per day, level of nicotine dependence (assessed by the
Fagerström Test for Nicotine Dependence. Their knowledge of influence of
genetics on nicotine dependence and regarding the influence of genetics on
smoking cessation (treatment) were assessed.

While 88.9% knew that it is important to quit, about half
(49.1%) of the respondents knew that less than half of the smokers who want to
quit succeed. As
far as knowledge was concerned most of the Dutch population did not know about
the genetic influences on smoking predisposition. About one-third knew that the
chance to become addicted to smoking is influenced by genes (29.5%) and that genes
exist that increase the chance of becoming addicted to smoking. only 36%
believed that genetic predisposition is an (very) important cause of smoking.

Instead of being
relieved by genetic tests most participants were worried that the results would
become known at work or to the employer and that they would not be able to tell
others. Participants were least
convinced that they would be relieved by the results and most convinced that a
genetic test would give a reliable result about the presence of a genetic
predisposition to become addicted to smoking, and that it could help to
determine the correct dose of smoking cessation medication.

While most participants
(73.6%) would prefer to receive more information as well as get the genetic
tests done from their General practitioners, they indicated not to be willing
to pay >€50 for the genetic test. A low number of participants (16.6%) were
(completely) interested in undergoing a genetic test and half of them (50.6%) would not ask their GP for the test.

Knowledge
level of participants on the influence of genetic factors on smoking addiction
and cessation, and even on basic mechanisms of heredity, is highly inadequate
and needs attention. Increasing
awareness of the probability and consequences of having a genetic
predisposition, and advantages and disadvantages for genetic testing, might
also be an effective strategy to motivate smokers to undergo a genetic test for
smoking cessation. Therefore it seems likely that General Practitioners
will play an important role in the counseling of patients about undergoing
genetic testing.

Further,
patients' awareness of such a test can also be increased by addressing via
other channels of communication, for instance, information leaflets or
information campaigns on TV, radio or in magazines or newspapers. Thus when
they have some knowledge about the influence of genetic factors on smoking and
smoking cessation they would prefer and look for these tests.

This study suffered from
few limitations as the field of
pharmacogenetic influences on smoking cessation is still in its infancy,
and therefore, no well-accepted tests to tailor smoking cessation treatment are
commonly available. The smokers may not be familiar with genetic testing for
smoking addiction and genetically tailored cessation treatments or even
genetics in general, it is questionable
whether they were able to give a well-considered answer to all the questions
they were asked. Lastly, that the participants were recruited via an
internet research company, selection bias
might have occurred due to the non-representative nature of the internet
population and the self-selection of participants.

Therefore we conclude that strategies for counselling
patients and communicating their test results have to be adopted by general
practitioners in a way to remove misconceptions regarding smoking cessation
rates.

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